HomeMy WebLinkAbout07-02-14 (3) REV-1500 EX(02-11)IF1) 1505611185
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of 60 Taxes INHERITANCE TAX RETURN
Po Box z80aoso1 21 13 1141
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
10232013 09291960
Decedent's Last Name Suffix Decedent's First Name MI
HAMBRIGHT LORAIN DERICK
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
F 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust l) 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name - Daytime Telephone Number
JACKIE R . PROCK 301-466-6706
N
REGIS ROFWILLSI5S9ONUY 3
s
c o m
First Line of Address
S 1
:a x. I-
11418 ASHLEY DRIVE — z !T 1 70
Second Line of Address
t� n
C F
City or Post Office State ZIP Code ` __4 FILED r" 1
J 1 N n
NORTH BETHESDA MD 20805 > co
Correspondent's e-mail address: ra Y r OG rn A t L . G t;� ;VA
Under penalties of perjury, I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPP NSIByy��FOR FIyyN�G RETURN 9�TE
c � U: ifs R 67/a� �� a rte!
ADDRESS
JACKIE R . PROCK, ADMINISTRATOR 11418 ASHLEY DRIVE, NORTH BETHESDA
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE MID 20805
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611185 OM46473,000 1505611185 \
J 1525611285
REV-1500 EX(Fl)
Decedent's Social Security Number
Decedent's N H A M B R I G H T 18RAIN DERICK
RECAPITULATION
I. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 831407 - 8 3
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2 0 - 00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). . , , , 3. 0 - 00
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4. 0 .00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , . . . , 5. 34,977 -7 6
6. Jointly Owned Property(Schedule F) F-1 Separate Billing Requested , , , , 6, 0 .00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) El Separate Billing Requested . . . . 7. 0 .00
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . 8. 1181385. 59
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. 241372 - 27
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , , , , , , , 10. 181670 .92
11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. 431043. 19
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12, 75,342 . 42
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13. 0 - 00
14. Net Value Subject to Tax(Line 12 minus Line 13) . 14. 751342 - 42
TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers un�er Sec.9116
(a)(1.2)X.o- 2 .20 15. 0 .00
16. Amount of Line 14 t xable
at lineal rate X- 4 9 0 . 00 16, 0 . 00
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 751342 - 40 18. 111301 - 36
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 111301 . 36
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Y.❑
Side 2
1505611285 1505611285
CM4648 3.000
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 13 1141
DECEDENTS NAME
HAMB IGHT LORAIN DERICK
STREET ADDRESS
5401 OXFORD DRIVE, APT- 16 LOWER ALLEN TOWNSHIP
CUMBERLAN COUNTY
CITY STATE ZIP
MECHANICSBURG PA 1?055-
Tax Payments and Credits:
1. Tax Due(Page 2,Lim 19) (1) 11,301 .36
2. Credits/Payments
A. Prior Payments 91000 . 00
B. Discount 450 -00
Total Credits(A+B) (2) 91450 . 00
3. Interest
(3) 0 . 00
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fill In box on Page 2,Line 20 to request a refund. (4) 0 . 00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,851 -36
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or Income of the property transferred X
b. retain the right to designate who shall use the property transferred or its Income . . . . . . . . . . ❑
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . H 51
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an"in trust for"or payable-upon-death bank account a security at his or her death?
4. Did decedent own an individual retirement account,annuity,or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ® ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent 172 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116 (a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent(72 P.S.§9116(a)(1.2)).
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 172 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 172 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
OM4671 2.000
REV-1502 EX-(12-12)
Pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF. FILE NUMBER:
Lorain Derick Hambricht_ 21 13 1141
All real property owned solely or as a tenant in Common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a wilting seller,neither being compelled to buy or sell,bath having reasonable knowledge of the relevant facts.
Real property that is joinHyawnptl with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. Property known and numbered as 83,407.83
5401 Oxford Drive, Unit 16, Lower Allen Township,
Cumberland County, Mechanicsburg, PA, sale value (see
attached settlement sheet)
TOTAL (Also enter on Line t,Recapitulation.) $ 83,_407.83
2w46e5 2 000 If more space is needed,use additional sheets of paper of the same size.
REV-15M EX-(0&12)
pennsylvania SCHEDULE E
DEPARTMEM OF REVENUE CASH, BANK DEPOSITS& MISC.
INHERITANCE rPX RETURN PERSONAL PROPERTY
INHEREM'DE TM RE
ESTATE OF: FILE NUMBER:
Lorain Derick Hambrioht 2113 1141
Include the proceeds of litigation and the dale the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Belco Community Credit Union 3,869.45
checking account ending 30-0040
2 Belco Community Credit Union 818.00
savngs account ending 30-0001
3 Cigna Assurance Program 26,909.81
account #64-023764-6
4 Internal Revenue Service 2,334.00
refund due the decedent on 2013 income tax return
5 Personal property 600.00
sale value
6 PPL Electric 50.00
refund on electric service
7 Wells Fargo 396.50
checking account 3625293497
TOTAL(Also enter on line 5,Recapitulation) $ 34,977.76
2W46AD 2.000 If more space is needed,use additional sheets of paper of the same size.
!EV.1510EX+(06-09) SCHEDULE G
pennsylvania
DEPARTMENT OFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC.NON-PROBATE PROPERTY
RESIDENT DECEDENT
?STATE OF FILE NUMBER
Lorain Derick Hambright 21 131141
This schedule must be completed and filed if the answer to any of questions t through 4 on page throe of the REVA 500 is yes.
DESCRIPTION OF PROPERTY
REM DATE OF DEATH %OF OECDS EXCLUSION TAXABLE
JUMBEF MTE of lPHZrai A\TM Aa OF nE occO FOR REAL asIAT¢. VALUE OF ASSET INTEREST IF Mpuc 6 E VALUE
I Vanguard 110,989.29 0.00
401K retirement plan, account
#093934. This is listed for
informational purposes only and
is not taxable due to the
decedent's age and his only
right was to, desingate a
beneficiary under the plan.
Designated beneficiaries were
Jackie R. Prock and Virginia
Verne (50/50 split)
TOTAL(Also enter on line 7,Recapitulation)s 0.00
If more space is needed,use addiliorm!sheets of paper of the same size.
9W*6AF 2.000
REV-15H EX-(
pe SCHEDULE H
pnnsylvania
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lorain Derick Hambrictht 21 13 1141
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FLINERALEXPENSES:
1 Jackie Prock
loan payable for payment made to Myers Buhrig
Funeral home for funeral services 11,000.00
Total from continuation schedules . . . . . . . . . 344.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 263.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Cumberland Law Journal
advertising Administrator's Notice 75.00
2 Jackie Prock
fiduciary bond fees 438.00
Total from continuation schedules . . . . . . . . . 12,251.77
TOTAL(Also enter on Line 9,Recapitulation) $ 24f372.27
9W46AG 2.000 If more space is needed,use additional sheets of paper of the same size.
Estate of: Lorain Derick Hambright 21 13 1141
Schedule H Part 1 (Page 2)
Item
No. Description Amount
2 Myers Buhrig Funeral Home
funeral services and graveside landscaping 344.00
Total (Carry forward to main schedule) 344 .00
Estate of: Lorain Derick Hambright 21 13 1141
Schedule H Part 7 (Page 2)
3 Lore Verne
repairs made to real estate which were required for
sale 600.00
4 MAS, Inc.
accountant fees 650.00
5 Register of Wills
additional short certificates 75.00
6 Settlement charges on sale of property
a. ReMax Realty, commission - $4,980.00
b. ReMax Realty - transaction fee - $175.00
C. Title services - $25.00
d. Deed preparation - $150.00
e. Tansfer taxes - $830.00
f. Resale certification - $75.00 6,235.00
7 Snelbaker 6 Brenneman, P.C.
legal services from 10/28/2013 to 11/4/2013 175.00
8 Snelbaker S Brenneman, P.C.
legal services from 4/22/14 to 6/25/14 1,550.00
9 . Sterling Property Management, Inc.
condo association dues 577.20
10 The Sentinel
advertising Administrator's Notice 210.78
11 Utilites (PPL Electric 6 United Water Pennsylvania)
water $105.79 6 electric $948.00 1,053.79
-12 Wayne L. Myers
appraisal fee - 125.00
13 Reserve
for filing fees, accountant fees and other
miscellaneous costs associated with the
administration of the estate 1,000.00
Total (Carry forward to main schedule) 12,251.77
REV-1514E%+p2-,2, SCHEDULE
pennsylvania
DEPARTMENTOF REVENUE DEBTS OF DECEDENT, _
INHERITANCE TM RETURN MORTGAGE LIABILITIES & LIENS
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Lorain Derick Hambright 21 13 1141
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Andrews 6 Patel
medical expenses 35.00
2 Belco Community Credit Union
mortgage payments made by the Executor 4,780.00
3 Belco Community Credit Union
mortgage payoff 12,827.92
4 Forest Park Rehab Center
medical expenses 334.00
5 PA Department of Revenue
tax due on 2013 income tax return 524.00
6 Pinnacle Health
medical expenses 70.00
TOTAL(Also enter on Line 10,Recapitulation) E 18 670.92
2w46AH 2.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX-( SCHEDULE J
Pennnsns ylvania
DEPAITINJ=MOFRMNUE . BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Lorain Derick Hambri ht 21 13 1141
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTROUDONS(Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Virginia Verne (formerly Troxell)
6 Heatherwood
Middletown, PA 17057
All of Residue: 75,342.40 _ Cousin 75,342.40
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET.AS APPROPRIATE.
II NONTAXABLE DISTRIBUTONS
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0.00
ew46AI 2.000 If more space is needed.use additional sheets of paper at the same size.
OMB Approval No.25040265
A. Settlement Statement (HUD-1)
B.Type of Loan
1.Q FHA 20 RHS 3.EXI Con,Unins. 6, File Number 7. Loan Plumber: 8. Mortgage InwranM Case Number'.
14072 1484313
4-Q VA 5.❑GOn¢ins.
shown.
C. Rote: This brm is lumishedN grte}ouestatementgfeCUat sedkmnnt P75ri Amoun.5pa#Matxfb/tlre settknreM agenf are
Items marked'(p.0.c)"were paid outside the ofoom;they are shown here for rHOrtnetionel purposes and are not ero5rded in the totals
D. Name and Address of Borrower E. Name and Address of Safer F. Name and Address of Lender:
Sandra Vrana Est.of Lorahr Dmija Ftambrigh Susquehanna Rink
Jodie R.Prhok.Admin. 3501 Concord Read
1077 Peter ,VVV York,PA 17402
Buckhannon,NN 26201 6401 c Odord Dries,Unit 16
MaGraniaburg.PA 17055
G. Roporty Lomfwn: ti. SedeentaAwell - L Settlement Date.
5401 Oxford Drina Unit 16 "one Central Seilbmerd Company LLC
Meilanirsburg,PA 17055 2595 Interstate Drive,Suite 101 May 19,2014
Cumberland County,Pennsylvania Harrisburg.PA17110 Ph. (717)909-1400
Place of Settkmen'L .
2595 Interstate Cure,SUde 501
Harrisburg,PA 17110
J. Summary of Borrawors transaction K. Summary of Snllofs tran section
100.Goss Amount Dun from Borrower__ 400�GOss Amount Due to Seller:
t0i.Contract sales prix 1 83,00000 401. Cem oCISaies rice t 83,000.00
102. Personal ro f -�- f 402. Personal receRY I
103 Settement Charges to Bmrw r(Une 5400) 5.598.05 403. f _
104. 404.
10:. I 405.
Moguar entsfartteres aid Seiler in advance Ad ustments forilems aidb SbIhonadvance
106 C own Taxes to 406.CdyfTown Taxes to
107. County Taxes 05120/14 to 0101/15 _230.30 407. Chun Tams 0620114 00 DIIDI115 I _ 230.36
10Ef. School Taxes 0521014 to 07101114 94.98 408.Schoni Taxes 05!20114 to 0701114 94.98
100. 2nd Dar Sewer 0`5 W14 to 0710 V t4 32,31 408.2nd Olr Sewer 0520114 b 07101/14 32.31
tt0. HOA day Dues Proration W20114 to OWOtii4 1 44 68 410.NOAti4iy OueS Proration 0111 14 06/01/14 _Y 44.68
5.
111, HOADue 0.er a Relent, 5.50 451.HOADoh Gyerp'rymnN Reimb :r0
112. I 452, i
129. Gross Amount Due from Borrower 69,[95.88 420.Gross Amount Due to Sellef
83,407.83
204.Amounts Paitl6 on in Behalf of BOmawer 500. Roducllonsin Amount DUe Salter.
201-DeR9 5'A w earnest money 1.000.00 501. Extess de' see¢tstrurtions)
202.Pr" mountdnow bents) .400.@3 502. Seitkmen4char as Splar Lune 1400 6.23500
20.3. E.Wi bans taken sub' m �'" 503. Exxon ban s taken sub' d to
264 Core for 10%Toer9 nce 9.95 504,Payoff First Mortgage to Be lcoCommunty Crept Un 12,927.92
263. J 505.Pa off Second Mort
206. 1 506.
207. 507. pepnsit dabs as proxedsj _,_ I
208. 508, 1
509,
ms. ,,.� _...�.
Adjustments foritems unDaitl by Seller Ad ustments for items unpaid by Seller
210. C' lfewn Taxes _ to 510.Cd/town Taxes to
211-county. T to 511. Conn Taxes to
212. Srslw[Taxes 10 512.Scficui Tales _., fo
213. " 513.
214. 514. _
216 516. ....
216. 516, 1
21Z Sits I i
219. 519.
it
220.Total Paid b ffof Borrower 67.409.95 520. Total]Roductum Amount Due Seller 19,162.92
300.Cash at Settiemont fromSo Borrower 680. Cash at settlement toffrom Seller
301. Gross amount due from Borrower(line 120) 89,9D5.88 601. Gms amount due to Seiler(ime 420) I 83.461.83
302 Less amount Paid bynor Borrower Pine 220) If 674409.95) 602. Less redu�etens due Seller(we 520) it 19.162.92
303. Cash E From I] To BDnower 21,595.93 603.Cash L,To C] From Seller 64244 91
'vas undersigned ho by;aJnowlefi�rU.al of err)
ThO undersgned hereby arJmaa'k-09e texpt of a mr.,pkted copy oFthi s Satemeni any atiad-is referred NO hera>t
Borrower andre _ y� � ✓ �y,,r Seller ,of(.Drab;Oar Hambryhi
Sen @a Vrana -""/'Y
J e R.ProH;.Rdmar..
nod rueam.tarn>rerzsma:rMmatimbnumawaASma.ln ca rotor.eM1x mieeiT.e..esre mie�rirynn4fa lNSaa.�rxm<cwrisxmmarm anm.remrrytemamnrrne
r ww�•�.ra4r.n,aama way..re..uo,nwwtrn:n.g.,.ev...a.tl�,r.rm+.v+r TUx,.a:eor.rand,xerow:ion.rtrsraa.�earmrrcn.m.aama.axirow.nimm
Page 1 019
HUD-1
(14072.PFO114072129)
1
L Settlement Cli es I
700.ToMt Rest FSWoBaoker Fags $4.980.00 Pad Flsn Paid Fran
OMsbn ofoeatayssi 4(bte 700)as folowr Baao s Baas
Fawss FaO$d
701 14 980 OD to RafM-x Reaft MIMiall0b.MIS to RdtMa%Raa ftOtessionah tnc �Ib"Oi $���
70 Commhsioh paid at nettlemenl d 980.00
701 Transaction Fee to Reavet.RealyProfesaanat, 175, 175.011
705.
am,Items paystle In Connection with Loan
01.Qa amination Charge Q'batkn Pdn4 0.i250x or 38.3.00 3 978.00 1 from GFE 01
802.Yon cedd a charge(pobLS)for the specific"vaeresl rate dwsOn i f hqn GFE 02
803.Yw seusted or'naaon mares t[pn GFEO 978.00
804.AW81sal fee to L,ndefsAOas hpm GFE 431 495.00
805,Credi Report to Caret eCredw hanGFE 03 28.00
We.Tax service to Core " Cfedm hom.GFE 03) 70.00
807.Flood cuffkx ion to WeLacik.Fkwd SeMces fnaa,WE a3 12.50
BOB. hart,GFE 0
809, firom'GFE 03
Bit. horn GFE 03
Bit. Shoot GFE 03)
M.items Required b Lender to 9a Paid In Advance
901.Daly Merest Charges kom 05119114 le OW1114 13 36.920JWM Irom GFE01 89,9fi
902.Mangano,:Tswana:prenuthe,for mwdhs to tram GFE 93
H000,a,ners b.angt for t.0 ar to (ftwbFE0nj
904, {ham GF£tit
905. (ItOm GFE 011
1000.Reserves Deposited with lender
1001.in3ial dCpoM far your asaaw aovunt Oroai GFEd9) 940.91
T662.HomefMmees bwrane0 3. month s 9. per menth S Te, a
1003.Mwtqao Inswanae Movitgi fp s w mlmh
1004.Propeq lazes $
Coanty Tams monlas $ PC, month
School Ta months S w mnnih i
1005, 3'
1006.County Tax 5.000 arordhs $ 37.19 pet month s 1 155.95
1007.SOW Tax 13000 nonfos fb 3 68.78 Pal Math 31 894.14
1008. $f
109.ME i $1 -157.92
11 M. gas
1101. Tile servkG and lenders Mb aliwaiwo tram GFEd4 1113,501 25.00
1102,Settlement or closing tea $1
1101,Ownees lik inwance to CM RqMbk Natonal Tile lnsurnon fiorn GFE 951 86.00
1104. a r'stik innwphfa to Oil RepublixNalional Tile inwr r>ce - 4? 958.50
1105.LeMers Rin amt - $ 66400.00 l I
1103. O.vners too poky End $ 830010 t
1107 Aqars pankan of hat total Iih,inwana4 ,mum to a4eC ntr seukmern Conway.LL S 898.02
1108. Undenvrders po,fion of the total tik llswance prenahnn to CldRepublic National Tile lnsicance Com - s r .156,48 f
1109. Deed Pr rattan to The Low,0712 of Mahnew L.Owens $1 - 150,40
1110 s'
1111. 3:
111 3'
1113. S
MO.Government Recording and Transfer Chariton 1 I
"I. reoNd' Czar es 10 Cumbedand Coun Reooderof Deeds hoar GFE V) 205.0
1;92. ] 107,00 Re.1n,ons It 4 Cthw 3 0
1203,Transfer taxes IQ C,xabanand Cownty Rtnxadar M Dee-ds Moat GFE 08 B
1204.CkyCwnW tandslanips .0 Mon p e
1..205.Slate au Deed s 630.0 Mon e S 830.0
1.'0.
1207.
1340.A iddionat Scat ic anon Charges 4
1301.RecaAraci sevbastapi ce on hap far then,GFE 06
1302. 3
1303.2014 C&Twp Tema to Rormk K M&r 3 P.O.C.sd52.34 5'
130/.2013Stlrool Taxes to Bona,K M3kr 3 P.O.C.382542(S)'
1305.Resale CenRCaton to Ste,kv Property uanagammt.In, 3 A627355 t305.lniialbn Fee, W Veaga of 7larabM fV Condombium ASwC 3 i 346.26
1307.June HM Des to Wage of MOrebM N CondomNkm Aaeaa 3 June dues 10.92
140.7.181 Senmmrnt Charges(Omar an iirtas 165 SeMian J and 502 Section H t 5.598.05
'PfeasYmadrvipgmm.n<W.reb451.teralU.Qarcm�iln ( f
0.'Mnarwn+d w.+uvne�.a+bw+le wm+tum,aeParmndaesWb ataY:]a ae4:.me,wn:vmrr
r
if
Keystone Central sue Ompany,114.Seaktrom Agent
Page 2 or3 HUD}I
(14072.FfOM4077f29)
Companson of Good Faith Estimate(GFE)and HUD-1 Charges
Good Faith Estimate HUD-1
Charges That Cannot Increase HUD-1 Line Number 978.00 97800
our origination charge 97800 978.00
Your adjusted origination charges #803 830.00 83000
#1203
Transfer lazes
Good Faith E
Chari That in Total Cannot lncrcase More than l0. stimate -1
HUD
#t201 160.00 2D5 OD
Cmemment ramrtling rha19es 89900 49500
Appraisal fee # 6D+ — 28.00
%805 28'00
Gcot report # 805 70.00 70.00
Tiu serwx 12.50 12.50
Fb3d certity2lbn # BD7
Total - 73050 81150
Invease between GFE antl 1U—D,Charges b 81 00 or 11.09-
crxod Faith Estimate HUD-1
Chages That Can Change 1407.80 94091
Inhial deposit for Your escrow amount 91001
%901 E 6.920000 1day 103.80 89.96
Daily interest charges 30009 115 00
Homeowner's insurance % 90J 1 214 00 1,11350
The i s services and lende line insurance #1101 88.00
88.00
Avner's title insurance to Old Republic National Tale Insurance Car #1103
Loan Terms
Your Initial loan amount is
E 6640000
Your loan term is 30.00 years
Your initial interest rate is 3 7500 9"
Yourinitial monthly amount owed for principal,interest and $307.51 includes'
any mortgage insurance is a Principal
❑ InteresA
❑ Mortgage Insurance
Can your interest rote rise? ❑ No ❑ Yes,Y can rise to a maxn mrh of 8.75000% The first
change wall be on1061012019 and can change again every 12 months after
061012019. Every change data )our interest rate can increase or decrease
by 2.00000':. Over the Ne of the ban,your interest rate is guaranteed
to never he lo•ser:than 2.25300%ce higher than 335W0%.
i
Even if you make payments on time can your loan balance rise? ❑% No ❑ Yes,it can fee to it marm um of b
Even if you make payments on time,can your monthly ❑ No ❑ Yes,the frat increase can be on 071012019 and the monthly
amount owed for principal,interest,and mortgage insurance rise? amount owed rah rise to$376.28
The maxinum a can ever rise to e:$487.29.
Does you r loan have a prepayment penalty? ❑X No ❑ Yes,your maxinum prepayment penalty's$
Does your loan have a balloon payment] ❑X No ❑ Yes.you Ikise a ba0oon payment of E
due in_years on
Total monthly amount owed including escrow account payments ❑ Youdo not have a m escrow Payment escro Payment for hems.such as property
lazes a�M homeowner's muranco. You must pay these Yams directly
yourself
❑X You have an additional monthly eacrow'payment of$115.55 that results
n a total inhalmonthy amoum orred of 5423.06. This includes
principal,interest,any mortgage Insurance and any items cheded ti
❑X Properlylaxes X❑ Homeownmr's insurance
❑ Flood insurance ❑
❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on th5 form,please condo,your lender.
Page 3 of 3 HUD-1
(14072.PFD/1407229)
HUD-1 Attachment
Borrower(s):Sandra Vrana Selle(s): Est.of Lorain Derick Hambright Jackie R.
Prock,Admin.
1077 Peter Road 5401 Oxford Drive,Unit 16
Buckhannon,VJV 26201 Mechank sburD,PA 17055
Lender:Susquehanna Bank
Settlement Agent:Keystone Central Settlement Company,LLC
(717)909-1400
Place of Settlement:2595 Interstate Drive,Suite 101
Harrisburg,PA 17110
Settlement Data:May 19,2014
Property Locagon:5401 Oxford Drive Unit 16
Mechanicsburg,PA 17055
Cumberland County,Pennsylvania
Additional Adjustments For Items Paid By Seller In Advance(Borrower Debit)
Description Amount FromlThrough Prorated Amoum
2nd Otr Sewer 70.00 04101/14 through06130/14 32.31
Total Line 1091409 - 32.31
HOA May Dues Proration 115.42 05101/14 through 05131/14 44.68
Total Lifts 1101410 44.68
Seller Loan Payoff Details
Payoff First Mortgage to Belco Community Credit Union
Loan Payoff 12,923.46 As of 0582114
Total Additional Interest 4.46 2 days @ 2.228600 Per Diem
Total Loan Payoff 12.927.92 .
Adjusted Origination Charge Details
Origination Charge
Origination Charge 978.00
to Susquehanna Bank
Total $ 978.00
Origination Credit/Charge(points)for the specific interest rate chosen
Total S
Adjusted Originatiop'Charges $ 978.00
Reserves Deposited with Lender
Homeowner's Insurance 28.74
County Tax 3.000 at 9.58 per month 185.95
5.000 at 37.19 per month
School Tax 894.14
13.000 at 68.78 per month
Aggregate Adjustment -167.92
Total S 940.91
Title Services and Lender's Title Insurance Details BORROWER SELLER
WARNING: It is a crime to knowingly make false statements to the United states on this or any similar form. Penalties upon conviction can
Include a fine and Imprisonment. For details am: Title 16 U.S.Code Section 1001 and Section 1010.
(14072.PFD/14072129)
HUD-1 Attachment- Continued
40.00
Coufier Fee
to Keystone Central Settlement Company,LLC 20.00
Tax Certification Fee
to Keystone Central Settlement Company,LLC
75.00
Closing Service Letter
to Old Republic National Title Insurance Company
30.00 5.00
Notary Fee
to Anne E. Houser
968.50
Lender's title insurance
to Old Republic National Title Insurance Company
Total $ 1.113.50 $ 25.00
Owner's Title Insurance BORROWER SELLER
Owner's Policy Premium 88.00
to Old Republic National Title Insurance Company i
Total ! 8 88.00 $ 0.00
I
Lender's Title Insurance BORROWER SELLER
•fees also shown abovo in Title Services and Lenders Thle Insurance 0elalls
Lender's Policy Premium 718.50
to Old Republic National Title Insurance Company
Lender's Endorsement Charges 250.00
Endorsement Endorsement Charge
ALTA Endorsement Form 4.1 (Condominium) 50.00
ALTA Endorsement Form 6(Variable Rate Mortgage) 50.00
ALTA Endorsement Form 8.1 (Environmental Protection 50.00
Lien)
Endorsement 100 50.00
Endorsement 300 50.00 -
Total I R 968.505 0.00
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. penalties upon conviction can
Include a fine and imprisonment. For details sec Title 18 U.S.Code Seaton 1001 and section 1010.
(14072.PF0114072 )
LAST WILL AND TESTAMENT
I, DERICK HAMBRIGHT, of the Borough of Mechanicsburg, County
of Cumberland and Commonwealth of Pennsylvania, being of sound
and disposing mind, memory and understanding, do make, publish
and declare this as and for my Last Will and Testament_, hereby
revoking and making void all former wills and codicils by me at
any time heretofore made.
FIRST. I order and direct that all my just debts and
funeral expenses be paid by my Executrix or Executrices, as the
case may be, hereinafter named, as soon as conveniently may be
done after my decease.
Y }
L ' SECOND. I give, devise and bequeath all the rest, residue
and remainder of my Estate, real, personal and mixed, whatsoever
and wheresoever situated, unto my mother, CLAIRE D. HAMBRIGHT, if
she survives me.
THIRD. If my mother, CLAIRE D. HAMBRIGHT, does not survive
me, then and in that event, I give, devise and bequeath all the
rest, residue and remainder of my Estate, real, personal and
fixed, whatsoever and wheresoever situated, in equal shares unto
y two cousins, namely, JANET LAHR and VIRGINIA TROXELL, share
and share alike, absolutely and in fee simple.
i
i
LASTLY. I nominate, constitute and appoint my mother,
ZAIRE D. HAMBRIGHT, to be the Executrix of this, my Last Will
and Testament, but if for any reason she should fail to qualify
as such Executrix or cease so to serve, then and in that event, I
""' OF1Enominate, constitute and appoint my two (2) cousins, namely,
SNEL64KE R.
eRE
SPARE IANET LAHR and VIRGINIA TROXELL, to be the Executrices hereof,
Q SPIRE
ach and all to serve without bond or other security as a
(condition of qualification hereunder.
IN WITNESS WHEREOF, I, DERICK HAMBRIGHT, have hereunto set
my hand and seal to this, my Last Will and Testament which
consists of two (2) typewritten pages to which I have affixed
my signature this it ii, day of .. A.D. , One
Thousand Nine Hundred Ninety-eight (1998) .
, .'�_ �..., ✓:.. - `�,. (SEAL)
Derick Hambright
The preceding instrument, consisting of one (1) other
typewritten page, identified by the signature of the Testator,
was on the date thereof signed, sealed, published and declared by
DERICK HAMBRIGHT, the Testator therein named, as and for his Last
Will and Testament, in the presence of us, who, at his request,
in his presence and in the presence of each other, have
subscribed our names as witnesses hereto.
LAW D-CES
SNELBAKER.
BRENN Eh1AN
SPARE
-2
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
We, DERICK HAMBRIGHT, RICHARD C. SNELBAKER and CHRISTINE M.
WHITE, the Testator and the witnesses, respectively, whose names
are signed to the attached or foregoing instrument, being first
duly sworn, do hereby declare to the undersigned authority that
the Testator signed and executed the instrument as his Last Will
and Testament and that he had signed willingly, and that he
executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator, signed the Will as a
witness and that to the best of his or her knowledge the Testator
was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
tator
Witness
witness
s� c�YI -Q
Subscribed, sworn to and acknowledged before me by DERICK
HAMBRIGHT, the Testator, and subscribed and sworn to before me by
RICHARD C. SNELBAKER and CHRISTINE M. WHITE, witnesses, this
day of 9'L•toL.Pi 1998.
oee¢ee Notary Public
SNELRAKER,
BRENNEMAN
aSPARE ..,...ram._...�.�.�.........-..r-..
Nalallal 9tx:4
PfD1W J.7lgmson,Notary P1fOh
Lcsdcxtc4l1rrpp Rom.CunttorlaM CmCt�
�.;y Comntl�lon E,P1rea noc.31,1C-
0'1TJT.PmreT 99 k-ne F."•RNM^�~